Back to Media Releases

Pilot sites chosen for Ont. primary care project

By Matt Borsellino

As many as 200 doctors and 300,000 patients may participate

HAMILTON ‚ Ontario's army of 11,000 family doctors now knows - finally - exactly where primary care reform will be tested.

Ontario Medical Association and provincial ministry of health officials announced the sites for a new model of care late last month. They are Hamilton, Chatham, Paris, Wawa and three Kingston-area villages, Sydenham, Verona and Sharbot Lake.

Site selection was much anticipated. It's been expected for nearly a year and comes more than two years after the OMA unveiled its reformed fee-for-service (RFFS) payment proposal for GPs.

In addition, different ways of changing the delivery of primary care have been considered by more than two dozen studies across the country over the last several years.

"This is an important step," said OMA president Dr. Bill Orovan in unwrapping the scheme at the office of a local GP here. "We've taken the time to launch this the right way in an effort to determine what works for both patients and their physicians. We look forward to receiving and carefully evaluating the results to determine whether to proceed further."

Dr. Sharla Lichtman, president of the Coalition of Family Physicians of Ontario (CFPO), said the delay reflects a reluctance by the Progressive Conservative government to deal with another major health policy issue.

"Clearly, hospital restructuring hasn't resulted in a positive public image for them," she said. "They probably learned a lesson from the way they rushed into that and decided to do things more carefully when it came to primary care reform."

As many as 200 family doctors, grouped into community networks, and 300,000 Ontarians could end up participating in the projects. Formal details on how those initiatives will work are expected to be concluded soon.

Patients who enrol will be guaranteed additional services by their provider network, such as expanded access to on-call services, after-hours phone advice from a registered nurse, and more prevention and education.

It's hoped visits to hospital emergency rooms will be cut by extending office hours and introducing a night-time and weekend phone advisory service staffed by nurses. Health policymakers in other provinces with congested ERs will no doubt be watching that aspect of the Ontario experiment with interest.

For doctors, there is a new funding formula described by the ministry as "unique." Funding is being designed to encourage GPs to consult on patient treatment plans not only with medical specialists but other primary care providers as well.

As expected, RFFS will be one of the payment mechanisms applied in the pilot project sites, along with capitation and global monthly funding, according to ministry documents. Capitation rates may later be adjusted to reflect living conditions and various community needs, states a ministry release.

Opposition

RFFS, developed by an OMA group chaired by Dr. Wendy Graham of North Bay, combines fee-for-service with "benchmark" capitation and has been the target of considerable opposition by concerned OMA members.

In fact, the entire primary care reform process and apparent product has weathered a storm of controversy and criticism. The OMA and CFPO, for example, have complained about not having enough input into pilot project design. Provincial health critics, too, have been vocal.

The CFPO's Dr. Lichtman said she's concerned about how results in small centres will be "extrapolated" for use in larger ones. "The profession still doesn't understand what primary care reform is all about, but because the system isn't working well right now and there's a proposal on the table, they're open-minded to change," she said.

"This means we need to carefully pick apart what works and keep it, while throwing out what doesn't. The significance of this is substantial. It's our entire future."

Dr. Kent Gerred, chairman of the OMA's section on general and family practice, said the sites were "chosen for reasons other than evaluation." Other sites would have fit the models better, he added.

"The sites were chosen by the minister without specific input by the OMA, though there were OMA representatives on the (provincial) steering committee (that worked on producing the pilots). I don't know what criteria were used. You have to wonder, though, about rostering in an isolated place like Wawa."

OMA board member Dr. Romas Stas also doesn't think the sites are very representative. "If we're going to look at the issue seriously," he said, "we have to look at how rostering will work in larger centres, not smaller ones, where patients are essentially rostered anyway."

NDP health critic Marion Boyd called the plan "another way of putting off real reform of primary care," while Gerard Kennedy, her Liberal counterpart, said it was "simply a public relations move . . . they're afraid to really do what primary care reform would require."

Back to Media Releases